Over the last several years, scientists have been learning more and more about how the health of your gut affects your health in general. More specifically, there is a growing amount of evidence to suggest that poor gut health makes you more susceptible to disease. Building off of that knowledge, recent research has found that there is a connection between COVID-19 and the gut.
This new study is claiming that systemic inflammation and abnormal gut permeability is linked to severe COVID-19.
COVID-19 and the Gut
One of the greatest mysteries of the novel coronavirus is the difference in the way it affects various individuals. Some people have the disease but have zero symptoms. Others get a stuffy nose and a sore throat, and others end up in the hospital, fighting for their lives.
Scientists have been digging into the reasons why this happens, and have come to a few conclusions. Essentially, your relative risk comes from three general categories:
- Your genes, biological sex, and age.
- Diseases and chronic conditions develop over time (i.e. underlying conditions).
- External living conditions (ie- your housing, working conditions, access to health care, etc.) 
This new report, which has not yet been peer-reviewed and is only in pre-print, zeros in on that second category. The researchers claim that people who’s gut barrier integrity is disrupted are more likely to develop a severe case of COVID-19, should they become infected .
Related: Leaky Gut: What is it? Is it real? And 11 Common Symptoms to Look Out For
COVID-19 Mortality and Gut Permeability
Scientists already know that lung damage interrupts the normal communication between your lung cells and your gut microbiome. This triggers systemic inflammation and severe disease. It also causes your gut barrier to break down, allowing gut microbes to cross your intestinal lining and enter into circulation. This, in turn, causes even more inflammation and damages your lungs further .
The researchers in this study found that patients with severe COVID-19 had significantly greater gut permeability, indicating that their intestinal barrier was not functioning properly. They used a few biological markers to determine this:
- A steep increase in the protein zonulin. According to the researchers, this is the only known physiological mediator of permeability in the tight junction in the digestive tract. This means that people with higher levels of zonulin likely have a higher level of gut permeability. Higher zonulin also happens to be a marker for higher mortality in severe COVID-19.
- Higher levels of plasma lipopolysaccharide (LPS) binding protein (LPD). This is a marker of acute infection or inflammation. Plasma LPD binds to bacterial LPS and triggers the immune system. The researchers say this is a sign that the patient has a “leaky gut”, which provides increased microbial access to the bloodstream.
- Higher levels of β-glucan (a fungal marker) and the tight junction protein occludin .
“These data support our hypothesis that disruption of intestinal barrier integrity, which results in microbial translocation, is linked to higher systemic inflammation and immune activation during severe COVID-19,” the researchers said in their report .
Researchers Predict Disease Severity
With this information, the researchers were able to use an algorithm to differentiate between mild and severe COVID-19. They were able to do so with an overall accuracy of 96 percent. This emphasizes even further the link between gut disruption and severe COVID-19.
But what does all this mean, exactly?
Basically, the link between COVID-19 and your gut is like a feedback loop. If you have poor gut health (aka, higher gut permeability), you are more likely to have a severe form of COVID-19 if you get sick. COVID-19, however, can also damage your gut, which could increase your risk of death from the disease.
The study also demonstrates that it might be possible to predict disease severity in COVID-19. Researchers can do this using biomarkers like plasma lipids and amino acids.
The good news is that the study also reveals some potential ways doctors could treat severe COVID-19. For example, they could inhibit zonulin, which would improve gut barrier integrity. Doctors could also inhibit other biomarkers that contribute to inflammation. This could prevent the cytokine storm that causes mortality in many COVID-19 patients.
The researchers end their study with the following conclusion:
“Greater understanding of the interaction between the gut, intestinal microbiota, and amino acid metabolism during COVID-19 might inform pharmaceutical and diet approaches to improve COVID-19 outcomes.” 
This study still needs to be peer-reviewed, as such should not be considered conclusive or used as a guide for improving health outcomes. Nevertheless, it is an encouraging step toward better treatment protocols for COVID-19.
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